A new study shows that music and noise-cancelling headphones significantly reduce anxiety and the need for sedation in critically ill patients.

MUSIC REDUCES ANXIETY AND SEDATION IN THE ICU

Critically ill patients who are hooked up to a mechanical breathing machine (ventilator) through a tube in their throat often experience significant anxiety and discomfort. Such patients generally require deep sedation with intravenous sedatives and narcotics, which impairs their ability to actively participate in their care and recovery.

A new prospective, randomized clinical research study suggests that patient-initiated music therapy can significantly reduce anxiety and discomfort, and reduce the need for sedative medications. This study appears in a forthcoming issue of theJournal of the American Medical Association.

In this innovative study, 373 patients admitted to 12 intensive care units (ICUs), at 5 different hospitals in Minnesota, were randomized into three separate groups. All patients were connected to a mechanical ventilator. In the first group, patients were able to self-initiate listening to music through headphones whenever they felt anxious or uncomfortable. (The selection of music for each patient was tailored to their individual preference by a certified musical therapist.) In the second group, patients were able to use noise-cancelling headphones, without music, whenever they felt anxious or uncomfortable. (This second group was designed to control for the potentially beneficial noise-suppression effects of listening to music through headphones in the first group.) Finally, the third group of patients served as the study’s “control” group, and this group of patients received standard ICU care, without music and without noise-cancelling headphones.

On average, the patients who listened to music through headphones experienced significantly lower levels of anxiety (based upon a validated anxiety assessment tool), when compared to patients who received only the usual ICU care. In fact, by the fifth day of this study, anxiety levels in the music group were 37% lower than the anxiety levels in the “usual care” group of patients. Patients in the noise-cancelling headphone group also appeared to benefit from a reduction in anxiety (due to the blocking of noise around them in the ICU).

A very important scientific aspect of this prospective, randomized clinical study was the monitoring and analysis of sedative medications administered to patients in each of the three study groups. Compared with the “usual care” group of patients, the patients in the music group required significantly less sedative medication throughout each day of the study. By the fifth day of this study, the patients in the music group required 38 percent less frequent administration of sedative medications, and the average intensity of their level of sedation was reduced by 36 percent (when compared to the “usual care” group of patients). Patients in the noise-cancelling headphone group also benefitted in terms of the frequency of administration of sedative medication, and the intensity of sedation required to keep them comfortable, although patients in the music group experienced an even greater reduction in the frequency of sedative medication administration.

The findings of this important ICU study confirm the calming effects of music therapy. The use of noise-cancelling headphones, to block out the often distressing sounds within the ICU environment, also appeared to provide a significant (but lesser) benefit to patients, when compared to standard ICU care.

While this study did not assess potential improvement in overall patient outcomes associated with music therapy or noise-cancelling headphones, such as time spent on the ventilator or time spent in the ICU, there is plenty of research data linking deeper levels of sedation with a prolonged need for mechanical ventilation and longer ICU stays, as well as other adverse patient outcomes.

Based upon the findings of this study, it would appear that music and noise-cancelling headphones should be considered as a new standard in the management of ICU patients who must be connected to a mechanical ventilator.

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Disclaimer: As always, my advice to readers is to seek the advice of your physicianbeforemaking any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author

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